Provider Demographics
NPI:1194953950
Name:GABLES FAMILY DENTAL, INC.
Entity type:Organization
Organization Name:GABLES FAMILY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-529-9295
Mailing Address - Street 1:2990 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3206
Mailing Address - Country:US
Mailing Address - Phone:305-529-9295
Mailing Address - Fax:305-529-2551
Practice Address - Street 1:2990 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3206
Practice Address - Country:US
Practice Address - Phone:305-529-9295
Practice Address - Fax:305-529-2551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GABLES SMILE & COSMETIC DENTISTRY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146721223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty